Provider Demographics
NPI:1952453508
Name:WISH, GAIL C (OT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:C
Last Name:WISH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:700 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5115
Practice Address - Country:US
Practice Address - Phone:360-923-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000208225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8947109OtherL&I CRIME VICTIMS
WA3622WIOtherREGENCE
WA5038WIOtherREGENCE
WA6539WIOtherREGENCE
WA8395295Medicaid
WA2638WIOtherREGENCE
WA233323OtherL & I
WA6290WIOtherMEDICARE
WA7683600Medicaid
WA233323OtherL & I
WAG8872112Medicare PIN
WA8395295Medicaid
WAGAB32264Medicare PIN